Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, interrupting or cutting off the blood supply of these organs.
Twisting causes sudden, severe pain and often nausea and vomiting.
Doctors use an ultrasound device inserted into the vagina (transvaginal ultrasonography) to aid in the diagnosis.
Surgery using laparoscopy is done immediately to untwist the ovary or to remove it.
An ovary and sometimes the fallopian tube twist on the ligament-like tissues that support them. Twisting of an ovary (adnexal torsion) is one of the most common medical emergencies in women. It is more likely to occur in women of reproductive age. It usually occurs when there is a problem with an ovary.
The following conditions make adnexal torsion more likely to occur:
Pregnancy if a large corpus luteum cyst is present
Use of hormones to trigger ovulation (for infertility problems)
Enlargement of the ovary, usually due to noncancerous (benign) tumors or cysts
A previous episode of adnexal torsion
Noncancerous tumors are more likely to cause twisting than cancerous ones.
Rarely, a normal ovary twists. Children and adolescents are more likely to have this type of torsion.
Adnexal torsion usually occurs on only one side. Usually, only the ovary is involved, but occasionally, the fallopian tube also twists. If the blood supply to the ovaries and/or fallopian tubes is cut off for too long, tissues in these organs may die, and the ovaries may not be able to function normally or the fallopian tubes may be damaged,
Symptoms of Adnexal Torsion
When an ovary twists, women have sudden, severe pain in the pelvic area. The pain is usually accompanied by nausea and vomiting. Before the sudden pain, women may have intermittent, crampy pain for days or occasionally even for weeks. This pain may occur because the ovary repeatedly twists, then untwists. The abdomen may feel tender.
The pain may be felt only on one side or be widespread throughout the pelvic area.
Some women have a fever or a rapid heart beat.
Diagnosis of Adnexal Torsion
Symptoms
Pelvic examination
Ultrasonography
Exploratory surgery
Doctors usually suspect adnexal torsion based on symptoms and results of a pelvic examination and ultrasonography.
Ultrasonography is done using an ultrasound device inserted into the vagina (transvaginal ultrasonography). If the ovary is twisted, this procedure may show an enlarged ovary or a mass in the ovary, which supports the diagnosis of adnexal torsion. Color Doppler ultrasonography can usually determine whether blood flow to the ovary has been cut off.
Surgery to view the ovaries is the only way to confirm the diagnosis.
Treatment of Adnexal Torsion
Surgery to untwist the ovary
If adnexal torsion is suspected, surgery is done immediately to check for a twisted ovary and thus confirm the diagnosis and, if it is twisted, to untwist it.
One of the following procedures is used to try to untwist and thus save the ovary:
Laparoscopy: Doctors may make one or more small incisions in the abdomen. They then insert a viewing tube (laparoscope) through one incision. Using instruments threaded through other incisions, they try to untwist the ovary and, if also twisted, the fallopian tube. Laparoscopy is done in a hospital and usually requires a general anesthetic, but it does not require an overnight stay.
Laparotomy: Rarely, doctors need to make a larger incision in the abdomen if the ovarian mass is larger. A laparoscope is not used because doctors can directly view the affected organs. Laparotomy requires a long period of observation after the procedure or an overnight stay in the hospital and can cause more pain after the procedure than laparoscopy.
If an ovarian cyst is present and the ovary can be saved, the cyst is removed (called cystectomy).
If the blood supply was cut off and tissue died, removal of the fallopian tubes and ovaries (salpingo-oophorectomy) is necessary.
If an ovarian tumor is present, the entire ovary is removed (called oophorectomy).
